Abortion

Lord Alton of Liverpool Excerpts

Thursday 3rd April 2014 Grand Committee

[Lord Alton of Liverpool (CB)]

My Lords, since the 1967 Abortion Act came into force on 27 April 1968, there have been more than 7 million abortions—around 600 every working day. I have some questions for the noble Earl.

As the law does not permit abortion on demand, and abortion was supposed to be a rarity, how in particular does the Minister explain the 66,000 repeat abortions last year—37% of the total—and the fact that, in some cases, individuals have had as many as nine repeat abortions? How does he explain that the majority of abortions are approved by doctors who have never even met their patients? Does he believe that Parliament and the law intended babies to be aborted after up to 40 weeks’ gestation on grounds such as having a cleft palate—breaking our laws on equality and discrimination? Does the noble Earl believe that Parliament wanted an estimated 4,700 girls to be aborted as just another choice, adding to the 160 million girls aborted worldwide?

Non-binding guidance is clearly not enough. Will he therefore amend the HSA1 and HSA4 forms to ensure that the two doctors required by law to authorise abortions only do so having directly asked whether the abortion is on the grounds of gender? On page 8 of its leaflet, Britain’s Abortion Law: What it Says, and Why, BPAS, which undertook 54,478 abortions last year with public money, asked:

“Is abortion for reasons of fetal sex illegal … ?”.

It then provides the answer, “No”. Why has the Minister not required BPAS to remove that advice? In a world in which we have such a low view of the intrinsic value of every life, what is being done to bring to book, using the Human Tissue Act, those National Health Service trusts that have been burning the human remains of aborted and miscarried babies to heat National Health Service hospitals?

These brief questions illustrate why the legislation needs, as the noble Baroness, Lady Knight, has told us today, careful review and amendment. Can the Minister think of a single comparable piece of legislation which has had such far-reaching consequences but has never been subject to post-legislative parliamentary scrutiny? Why does he think that is and will he ask the Secretary of State to consider allowing it?

[Lord Campbell-Savours (Lab)]

My Lords, we have half an hour left of this debate, and I wonder whether I could speak very briefly in the gap and ask a question.

NHS: NICE-appraised Medicines

Lord Alton of Liverpool Excerpts

Thursday 27th February 2014 Lords Chamber

[Earl Howe]

My Lords, patients have a right under the NHS constitution to access clinically appropriate drugs and treatments recommended by NICE technology appraisals. That is a legal right. If a prescriber has failed to adhere to that, a clinical commissioning group is bound to find in the patient’s favour. However, there are clearly individual circumstances for each case that need to be looked at. The key is that the patient is entitled to expect a transparent and fair process where the reasons for a decision are published.

[Lord Alton of Liverpool (CB)]

Given that the noble Earl has just referred to the Question of the noble Lord, Lord Hunt, about access to new, innovative medicines, will he undertake to look at material which I have sent to him today from the Toronto-based mesothelioma research institute, which has developed new, innovative treatments for mesothelioma victims and may hold hope for some of the 2,200 who die of that horrific disease in this country every year?

[Earl Howe]

Mesothelioma is a devastating disease, and I certainly undertake to look at the material that the noble Lord has sent me.

Mesothelioma: Research Funding

Lord Alton of Liverpool Excerpts

Thursday 16th January 2014 Grand Committee

Asked by

[Lord Alton of Liverpool]

To ask Her Majesty’s Government what progress has been made in the funding of research into mesothelioma.

[Lord Alton of Liverpool (CB)]

My Lords, today’s letter in the Daily Telegraph, signed by 13 Members of both Houses drawn from all parties, once again underlines the case for doing far more to find the causes of, and cures for, mesothelioma—a devastating disease which annually claims around 2,200 lives and which is likely to kill more than 50,000 more British people unless new treatments are found.

Let me begin by thanking my fellow signatories and all those taking part in today’s debate. This cause was one about which my good friend, the right honourable Paul Goggins, Labour Member of Parliament for Manchester Wythenshawe, felt deeply. He spoke extensively in Committee on the Mesothelioma Bill. He, and the Conservative Member of Parliament, Tracey Crouch, tabled amendments on Report, based on the amendments narrowly defeated in your Lordships’ House, which would have created a small levy to fund mesothelioma research. Just before the Christmas Recess, he and I once again beat a path to see Ministers to raise the plight of victims of mesothelioma. It was one of the last things that Paul did. After a massive stroke, which robbed him of life, and which robbed Parliament of a good and principled man, Paul was buried earlier today. Our thoughts are with his family. This debate, and the continuing fight for justice for victims of mesothelioma, and the need for sustained and adequately funded research, is the best tribute which we can offer him.

During our meeting at the Ministry of Justice with the noble Lord, Lord McNally, we asked about the review required by Section 48 of the Legal Aid, Sentencing and Punishment of Offenders Act 2012 into the effects on mesothelioma claims of its Sections 44 and 46. This brings us full circle, to the House of Lords debate, in which the House rejected the LASPO CFA reforms as sufficient to justify imposing legal costs on mesothelioma sufferers. When I tested the opinion of your Lordships’ House, noble Lords rejected the Government’s proposal that CFA reforms lifting damages for pain and suffering by 10% would compensate for the deduction of 25% of those same damages in success fees.

On 4 December, the Government issued a statement abandoning the consultation reforms in the face of overwhelming opposition from the claimant community, but stated that Sections 44 and 46 would be brought into force for mesothelioma sufferers, stating:

“The Government does not believe that the case has been made for mesothelioma cases to continue to be treated differently”.—[Official Report, 4/12/13; col WS 28.]

I refer the Minister to the recent Legal Ombudsman’s report on no-win no-fee agreements, stating that there is evidence of some lawyers failing to make clear the financial risks of conditional fee agreements and trying to pass on the risk to customers. That is precisely the situation your Lordships feared, and would not tolerate dying mesothelioma sufferers facing. That is why, on two occasions, we defeated those proposals and agreement was reached to have a review. However, as Mr Goggins and I made clear to the noble Lord, Lord McNally, there has been no review worthy of the name. The Government have simply restated their original argument.

The crucial point is that any scheme should deliver no less favourable compensation than is presently provided. Victims deserve nothing less. I hope that the Minister will comment on this. During our ministerial meeting, we linked this question to that of research because if cures and causes were identified, such issues would be otiose. In any event, investment in mesothelioma is in its own right desperately needed. The UK has the highest rate of the disease in the world. The annual number of mesothelioma deaths in the UK has nearly quadrupled in the last 30 years.

As I argued during the proceedings on the Mesothelioma Bill, it cannot be in anybody’s interests, not least that of the insurance companies, to pay out vast sums of money in compensation and to generate the full panoply of schemes, reviews, fees, CFAs and litigation, if causes and cures for mesothelioma could be identified. That is why, under the auspices of the British Lung Foundation, to which I pay great tribute, and with the assistance of the Department of Health, a handful of enlightened insurance companies—AXA, Aviva, RSA and Zurich—have been generously funding some of the research. However, as we know, that money has come to an end. A statutory scheme with a small levy on all companies would be both fairer and, perhaps more importantly, a sustained source of funds for research.

With this very small level of funding, the results have been impressive. New researchers from other areas of therapy have started to take an interest in mesothelioma, bringing with them new expertise and insights. Europe’s first mesothelioma tissue bank, which I think we will hear more about from the noble Lord, Lord Avebury, has been created to collect and store biological tissue from mesothelioma patients for use in research, and work is being funded to identify the genetic architecture of the disease. The evidence demonstrates beyond doubt that investment in mesothelioma is worth while. However, all the original funding has now been allocated and we look forward to hearing from the Minister what new funding will be forthcoming to continue this work.

A sustainable, reliable voluntary agreement involving all or most of the 150 firms with an active interest in the employers’ liability insurance market would be difficult and impractical. It is for that reason that the Government will ultimately have to intervene in order to make this funding compulsory and fair, so that it is spread across the entire industry. I was particularly concerned to hear a defensive Minister, Mike Penning, say during debate in the House of Commons in his role as Minister of State at the Department for Work and Pensions,

“I cannot break the deal”—[Official Report, Commons, 7/1/14; col. 204.] ,

implying that the deal to get the Mesothelioma Bill through both Houses prevented a statutory levy being secured. Happily, as they say, that is now history and I hope that Ministers will look again at this question. The Conservative Member of Parliament, Dr Sarah Wollaston, who supports the proposal for a statutory levy, has told me that she would particularly like to see scientific research which supports the development of better technologies for preventing exposure and the emerging technology for real-time detection of asbestos fibres, which could significantly reduce the risk of avoidable future cases.

These small sums would make a huge difference to the future of mesothelioma research in the UK and could potentially lead to cures, which would save tens of thousands of lives. It is estimated that 150 insurance firms are active in the market and that a small contribution from each could raise a vital £1.5 million each year for research.

I now want to say something about the alleged lack of quality of research applications. On several occasions, the Government have suggested that the lack of research is due to the poor quality of research proposals and not the funding available. Happily, this misconception has now been thoroughly debated in the other place and Ministers have conceded that that is not the case. During the debates in the Commons, Paul Goggins referred to the work of Stephen Holgate, MRC Clinical Professor of Immunopharmacology at Southampton University and chair of the British Lung Foundation’s scientific committee. Stephen Holgate says:

“It is simply not true to state the quality of mesothelioma research applications is not up to standard”.

From what he called the “very meagre starting point” of existing funding, he says that the work already undertaken,

“has been of an exceptionally high standard”.

Therefore, the practical and moral case for the industry having a duty to fund mesothelioma research, and the Government’s responsibility to ensure that it does, is abundantly clear. However, it is also clear that, even if some funding were to be made available through the voluntary route, it alone would not address the core issue at stake here, which is sustainability. Therefore, while welcome, sponsorship of specific projects in isolation will not be an appropriate way forward. It is incumbent on us to find one that is.

With the opportunity having passed for putting sustainable future funding for research in the Bill, I hope that the Minister will today give a concrete guarantee for a long-term, sustainable research programme. Such a scheme could be achieved either though securing long-term investment from the insurance industry via a voluntary scheme or by introducing, as I hope we ultimately will, a statutory measure making contributions from that industry to fund mesothelioma research compulsory. However, we also need a commitment today that the Government will make this happen, a date by which the Government will ensure that a scheme is in place and an assurance that such a scheme will be of the value of at least £1 million every year.

Mr John Edwards, consultant thoracic surgeon at Sheffield’s Department of Cardiothoracic Surgery, sums up the arguments in the following way: first, that government, industry and insurers do not want to fund the immense costs of treatment, benefits and litigation for mesothelioma; secondly, that patients and their families would much rather have their lives back than any benefits or compensation; thirdly, that researchers have plenty of ideas but not enough funding; and, fourthly, that current treatments may have benefits in palliation of symptoms and a modest increase in life expectancy but do not cure the disease. In other words, there would be huge benefits to the health of the nation if the insurance industry were to invest likewise in research.

Mr Alan McKenna, an academic who teaches law at the University of Kent, has seen several members of his family contract asbestos-related diseases. Last week, he launched an e-petition to the Government calling for more research into mesothelioma. In the House, a Private Member’s Bill will shortly be introduced.

I read last week of a journalist who was in her 50s and who, like her nine year-old daughter who had died a year earlier of mesothelioma, had succumbed to the same fatal disease. We are all aware, too, that there have been fatalities among family members of several senior colleagues in both Houses; just before today’s debate, the noble Lord, Lord West, told me that 10 of his contemporaries at Dartmouth have died of mesothelioma. These may be added to the thousands of men and women who contracted this killer disease simply by going to their place of work.

--- Later in debate ---

[Earl Howe]

My Lords, I note my noble friend’s question. My best answer to him at this stage is “one step at a time”. However, I can assure him that we will use our best endeavours to see a successful outcome from our discussions with the insurance industry. It is perhaps premature for me to go further at this stage.

[Lord Alton of Liverpool]

My Lords, I am grateful to the Minister, and I promise not to interrupt again, but can he provide further clarity about this £250,000? Is it drawn only from the four companies that have been referred to? How many of the 150 companies are contributing to it? What does it represent in terms of what is currently available from the industry?

[Earl Howe]

My Lords, as this is a time-limited debate, perhaps the noble Lord would accept my undertaking to write to him with those details. I am not sure, in fact, that I have them, because the letter, although extremely welcome, is quite brief in the detail it gives on the source of the funding.

Mesothelioma

Lord Alton of Liverpool Excerpts

Thursday 5th December 2013 Lords Chamber

Asked by

[Lord Alton of Liverpool]

To ask Her Majesty’s Government what funding has been secured for research into the causes of and potential cures of mesothelioma.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the Government are fully committed to research into the causes of this dreadful disease and into potential treatments. The usual practice of the main public funders of health research is not to ring-fence funds for expenditure on particular diseases, and funding is available for high-quality research proposals. With its partners, the Department of Health is actively pursuing a package of measures that we believe will stimulate an increase in the level of research on mesothelioma.

[Lord Alton of Liverpool (CB)]

While thanking the noble Earl for his reply, does he recall the assurance he gave to the House, when an all-party amendment—which would have created a small, statutory levy to support mesothelioma funding—was defeated by 199 votes to 192, that insurance companies would voluntarily step up to the plate? Given that there have been 2,400 deaths from mesothelioma this year, with 60,000 anticipated over the next 25 years, and with the imminent ending of even the existing insurance industry funding, would it not be shameful to leave unfunded research that could save lives and prevent vast expenditure on compensation? The Mesothelioma Bill is now before another place, with an amendment supported by both Conservative and Labour Members of the House of Commons. Surely Ministers should be looking again at this practical way of finding a cure for this deadly disease.

[Earl Howe]

My Lords, I understand that the British Lung Foundation has had discussions with representatives of the insurance industry about extending the funding for research, but that no commitment has been made by the industry so far as to future funding. As I made clear during the debate, the issue holding back progress is not the lack of available funding—there is plenty of that—but the lack of sufficient high-quality research applications. The money previously donated by insurers is supporting valuable research, as the noble Lord, Lord Alton, has said. At the moment, a greater volume of mesothelioma research is supported by the Government, and we believe that the package of measures that I mentioned will stimulate an increase in that volume.

Abortion

Lord Alton of Liverpool Excerpts

Thursday 6th June 2013 Lords Chamber

[Earl Howe]

My Lords, the Care Quality Commission has put in place procedures to identify pre-signing or other instances of non-compliance, and they are confident that these would now be picked up during inspections. However, my noble friend is right; there was a concern early last year that this pre-signing was happening. Since then, however, the CQC has been working directly with providers who are registered to provide termination of pregnancy services to ensure that they are complying with the requirements of the Act. It is beginning to explore how it can strengthen the registration process alongside its regular inspection activities. I therefore suggest to my noble friend that it is not a case of nothing having happened.

On sex selection, we have no evidence at all of gender-related abortions in the UK. Again, concerns were expressed about this in the press, but analysis has been done that shows that the UK birth ratio is within normal limits.

[Lord Alton of Liverpool]

My Lords, does the noble Earl accept that some cases were referred to the police last year where gender abortions were identified? Will he welcome the decision of Ranjit Bilkhu and a group of Asian women in this country to set up an organisation to challenge the attitude that it is permissible to take the life of an unborn child merely because of its gender? Has he noted the Private Member’s Bill of the Member of Parliament for Congleton, Mrs Fiona Bruce, and the Early Day Motion, signed by more than 50 Members of another place, drawing attention to the need at least to collect the data where the gender of a child is known so that we can truly know whether or not this phenomenon is occurring in this country as it does in many other parts of the world, where the three most dangerous words are, “It’s a girl.”?

[Earl Howe]

My Lords, I am aware of all the initiatives mentioned by the noble Lord. The issue of the sex selection of foetuses is, of course, extremely serious. However, as I mentioned in my earlier Answer, following extensive investigation and analysis we do not believe that there is any evidence that this is happening in the UK. That is the prime reason why we do not agree with the noble Lord that measures should be put in place to collect data regularly on the sex of the aborted foetus. Were we to do that it would require changes to legislation. It would also require changes to clinical practice, and it has ethical implications. I hope the noble Lord will understand that we have thought about this very carefully.

Abortion

Lord Alton of Liverpool Excerpts

Tuesday 4th December 2012 Lords Chamber

[Earl Howe]

My Lords, my noble friend raises some extremely important questions. The House will remember that reports came to light in February of pre-signing of the HSA1 forms—the approval forms that have to be signed by two doctors—and the CQC carried out a serious of unannounced inspections of all abortion providers in the light of that story to uncover any evidence of pre-signing. As a result, 14 NHS trusts were found to be non-compliant and clear evidence of pre-signing was identified. We await the outcome of investigations by the Metropolitan Police on that issue. Of course, as a department, we take it very seriously indeed.

On the issue of sex selection, my noble friend is absolutely right. The Act stipulates specific circumstances in which termination of pregnancy is permitted. Gender selection is not one of those circumstances. It is illegal for a practitioner to carry out an abortion for that reason alone, unless the certifying practitioners consider that an abortion is justified in relation to at least one of the Section 1(1) grounds in the 1967 Act. My noble friend will also be pleased to know that the Chief Medical Officer for England has written to all clinics and hospitals undertaking abortions to remind them of the provisions of the Abortion Act.

[Lord Alton of Liverpool]

My Lords, is the Minister familiar with a report that recently appeared in the Economist, which said that around 100 million abortions have taken place throughout the world on the basis of gender, which it calls “gendercide”? Does he not agree that in a country where routinely, every working day, there are some 600 legal abortions there is a real danger that, culturally, people imagine that it is simply a right to choose to take a life on whatever basis they believe it reasonable to do so? Can he therefore spell out again the illegality of taking the life of a child on the basis of its gender? Can he tell the House what penalties there will be when such actions occur and how long it will be before the police inquiries complete their course?

[Earl Howe]

In answer to the last question I have no firm information about when the police inquiries will complete their course. They have been ongoing for some months. The noble Lord, Lord Alton of Liverpool, is right to raise his concern, but I can again state emphatically that under the law of this country it is illegal to perform an abortion on grounds of sex selection alone. If evidence of such practices comes to light, the penalties are that the doctor or doctors concerned may be referred to the GMC. The Care Quality Commission will be called in and there will be the possibility of police investigation and prosecution resulting. This is not something that any provider of NHS-funded abortions should ever consider doing.

NHS: Liverpool Care Pathway Inquiry

Lord Alton of Liverpool Excerpts

Monday 5th November 2012 Lords Chamber

[Earl Howe]

My Lords, there is never any cause for complacency in a matter of this kind, and I can reassure my noble friend that the Government will keep this issue under review. At the same time, I hope she will allow me to respond in slightly more forthright terms than I normally do, because there has been an enormous amount of misreporting and misinformation around the Liverpool Care Pathway, which has been endorsed publicly in a consensus document by 22 of the leading professional organisations and patient organisations in this area, including Marie Curie. We cannot ignore that. As I mentioned in my Answer, some of those organisations are looking carefully at the reports to which my noble friend alluded. It is notable that not a single complaint has reached the regulators in this area, which I suggest indicates that there may be less substance to some of these stories than may first reach the eye. However, I emphasise that there is no complacency.

[Lord Alton of Liverpool]

My Lords, as the noble Earl comes to look at the consultation on the National Health Service constitution over the coming months, will he take the opportunity to look at the care pathway in Liverpool itself, where last week I was able to meet Professor John Ellershaw and those who devised the pathway? Given that 80,000 patients a year are treated on the pathway, does the Minister accept that it works very well for many of them; that while the philosophy is not the problem, the procedures used in some places have been; and that one of the principal concerns is dehydration? Does he agree that that is something to be looked at, as well as the level of training of those doctors who are responsible for the palliative care of people at the end of their lives?

[Earl Howe]

My Lords, I fully agree with the noble Lord. Training is integral to the care pathway, as is the need to consult the families of patients and, if possible, the patients themselves before a decision is taken to put them on the Liverpool Care Pathway. On the NHS constitution, I completely take the noble Lord’s point. The proposed change to the NHS constitution makes it absolutely clear that patients and their families and carers have the right to be fully involved in discussions and decisions about their care, including that at the end of life. We are clear that that should already be happening, but we understand from reports that that is not always the case. As regards end-of-life care, I think there is sometimes a taboo on discussing death and dying and press reports show how damaging that can be. I shall indeed take all the noble Lord’s points on board, particularly as regards nutrition and hydration.

Diabetes

Lord Alton of Liverpool Excerpts

Tuesday 10th July 2012 Lords Chamber

[Earl Howe]

My Lords, we keep the question of taxation under review in the light of emerging international evidence on its impact. That will include looking at the experience of the recently introduced tax on saturated fat in Denmark and what effect it has had on diet and health. With any fiscal measure, there is always a risk of unintended consequences, so we would have to look at this particularly carefully.

[Lord Alton of Liverpool]

My Lords, did the Minister have a chance to see the report from the London School of Tropical Medicine and Hygiene, published earlier this month, which suggested that if obesity levels could be reduced, there would be sufficient food for 1 billion people worldwide. The report pointed particularly to the United States of America and at western Europe. Does this not both justify the Government’s campaign to reduce obesity and illustrate the truth of Gandhi’s remark that there is sufficient in this world for people’s needs but not for their greeds?

Human Fertilisation and Embryology Authority/Human Tissue Authority

Lord Alton of Liverpool Excerpts

Tuesday 1st February 2011 Grand Committee

[Lord Alton of Liverpool]

My Lords, the noble Baroness has laid before us a Question that rightly draws attention to two issues: public safety and public confidence. They are the issues that the Minister rightly addressed last week when he kindly and courteously invited us to be given a briefing about the Government’s intentions.

For me the jury is out on these issues. I would certainly want to see, at the very minimum, a reform of the HFEA. The Minister will recall, as other noble Lords will, the debates that we had during the passage of the Bill, when a number of us argued for the creation of a national bioethics commission to oversee some of these ethical issues. I suppose that I subscribe to the cautionary verse of Hilaire Belloc, who said,

“always keep a-hold of Nurse

For fear of finding something worse”.

I would like to see the colour of the Government’s money. I want to see precisely what they have in mind before coming to a conclusion.

It is worth going back, as the noble and learned Lord did in his remarks, to the creation of the HFEA. As the noble Baroness, Lady Warnock, has said, it was necessary to create it—these were the words of the Warnock report—

“if the public is to have confidence”.

She said that it needed to be an “independent body”, that the membership was,

“not to be unduly influenced by sectional interests”,

and that its membership was to include,

“a diverse range of views”.

She also laid great emphasis on what she described as the,

“special status of the human embryo”.

I have a Question on the Order Paper at the moment asking the Minister to update the figures given to us by the noble Lord, Lord Hunt of Kings Heath, during the passage of the legislation two years ago, but the figure that was given then was that some 2 million embryos had been destroyed or experimented on since the passage of the 1990 legislation, so these are not trivial questions. The question of the status of the human embryo has always struck me as central to this argument.

I note that the chair of the HFEA, Professor Lisa Jardine, said in the Guardian on 5 January that,

“the safeguarding of the ‘special status of the embryo’ will be lost”,

if the HFEA is abolished. In an article in the journal Nature last August, it was suggested that,

“losing the HFEA as a discrete body could undermine public confidence”.

The article on Professor Jardine adds that the HFEA,

“carefully shelters human embryos from routine experimentation”.

Perhaps the Minister could tell us whether he has asked how many embryos have been thus spared; surprisingly, the HFEA, via Parliamentary Questions, says that it cannot tell.

Whether it is the unnecessary destruction of human embryos, the dangers caused to women by hyperovulation syndrome—before the Committee met today I passed the Minister a new paper from a German medical magazine about this question, because it goes right to the heart of patient safety—the ethics and mercantile nature of exploiting poorer women through the sale of eggs, an issue that the HFEA is currently considering, or the extraordinary way in which the HFEA has, for instance, pursued Dr Mohamed Taranissi, requiring it to meet legal costs of nearly £190,000, it is obvious, as the current HFEA chief executive stated in a memo, that,

“something clearly has gone wrong—badly wrong over a sustained length of time”.

At the very minimum, I think that reform is needed.

I would therefore be grateful to hear how Her Majesty’s Government propose that there should be what the Minister himself has described as a “lighter touch”. Is that something that people such as me should be fearful of, or should we welcome it? Does it mean that in any sense there will be less regulation? Will the status of the human embryo be diminished further? How will the exercise of the HFEA’s powers through this lighter touch be done? Also, how will the Government ensure that the requirements of the Human Fertilisation and Embryology Act, which stand in place, will be adhered to if the HFEA ceases to exist in its present form? Who will be responsible for the transfer of sensitive data that the HFEA holds? How will independence, freedom from undue influence or sectional interests and a diverse range of views be upheld?